Category: Reflection

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Disaster Nursing

Nurses play a valuable role in health care but they can also play an important role when disaster strikes. There are various tasks that a nurse can do to help any disaster situation, whether it is natural or man-made. A key job that a nurse can do is assessing patients. This can be done to determine how severe patients are from the disaster. Assessing patient’s helps doctors organize who they need to treat first. Things can get pretty hectic when a disaster occurs. It is important that the nurse remains calm and collected when assessing patients. Nurses also can’t hold be afraid to tell it like it is. If a patient is near death and has a low probability of survival, the nurse needs to make the decision to provide comfort and let the patient live out the remainder of their life. Nurses can also contribute by providing patients with first aid and medications. If people are in need of help but their injuries aren’t as extensive as others, a nurse can jump in and provide first aid. This could mean stabilizing a patient with a suspected spinal cord injury or tying off a gushing wound by providing pressure. These tasks can help save patient’s lives. Medication administration is also valuable in providing comfort to patients. Pain medications can be used to help alleviate immediate pain. When dealing with all of this commotion, a nurse needs to be able to step back and think about their own safety before jumping into something that can danger themselves.

The ANA Code of Ethics can present conflicting Provisions as a nurse has a duty to care for a patient yet, care for themselves. These two Provisions can conflict each other in times of disaster. In these types of situations, a nurse has to think about themselves and the issue at hand. If saving someone’s life is going to cost your own life, then that is not worth it. A nurse can only do some much in certain circumstances. It can be challenging for a nurse to make this decision. When a nurse spends their whole career helping people in need, these decisions do not get any easier. Sometimes, a nurse may need someone else to explain to them that helping someone in a certain situation can lead to harming themselves. The judgement is left up to the nurse as they should do what they feel comfortable doing. It would not be considered a breach in one code over another when they involve endangering yourself or the patient. 

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Reflective Writing

Having clinical rotations at Maine Medical Center has played a big part in enhancing my nursing knowledge by allowing me to get hands on experience. With this, I have been able to communicate with patients, practice critical nursing skills, and collaborate with other health care members. These experiences are invaluable and have given me great experience. With every patient encounter, something always sticks with me. Whether it was a friendly patient or a patient who is truly relying on our help to improve their quality of life, I take away something special from each patient.

            Specifically, I remember an encounter with a patient that has stuck with me since. This patient was critically ill and needed a heart catheterization with a possible coronary artery bypass graft to help diagnose and resolve what was going on. Chronic heart failure was the primary diagnosis along with an acute exacerbation of a kidney injury. The patient was retaining fluid and had difficulty with mobility. They required a lot of assistance with things such as eating, going to the bathroom, and changing position in their bed. This patient, even with all their difficulties, was one of the most optimistic patients I have ever cared for. They were extremely polite and grateful that we were able to help him. I was amazed at how appreciative and happy this patient was even though they were in a critical condition. It made me think about all the little things that may have annoyed me and made me realize that they were not that big of a deal compared to this patient.

            During the encounter, a lot of things went well. I was there to assist this patient to the restroom. Even though challenges in mobility existed, we were able to slowly use the walker and get the patient to the restroom. During breakfast time, I was able to assist the patient in eating. I opened their milk and containers which helped this patient greatly as they hand strength was diminished. This allowed the patient to eat their meal which will provide them will the proper nutrition to help their diagnosis. I was able to help this patient get washed up for the day via a bed bath. Getting the patient cleaned up can help reduce the risk of having the patient’s skin break down which could develop into a pressure sore or ulcer. The patient was very responsive and let me do what had to be done. These things went well for me as I communicated with the patient through each step of the procedures. They were understanding and willing to participate in each process. I was grateful for this as the patient knew the tasks that I was doing and that it was going to help them. Not everything went well through this encounter. The patient was hard of hearing and it was challenging at times to verbalize what I was going to do and if I had any questions. I used the white board on in their room to write out things that I was going to do throughout the day. This helped bridge the communication so that the patient was informed and ready to actively participate. I should have used this method of communication early during my time so that things could of went more smoothly. Another thing that I could also improve upon is my confidence. This encounter happened earlier in the semester and I was not as confident in my skills as I am now. Clinical has provided me with learning opportunities which has built my confidence as a nurse.

            Analyzing this patient in a different perspective, I am able learn more about their demographics and social determinants. Each patient has different health equity and different levels of access to care. The patient that I was taking care of had limited access to care. They lived in an area where health care was not something that was easily accessible. The last time this patient went to the doctor was five years ago. With this, this patient has a lot of new diagnosis such as type 2 diabetes as they have not been able to regularly trend their health. This lack of accessibility could have played a role in their current health by not allowing them to treat issues when early warning signs present. This patient was also at a disadvantage economically and could not afford most of their medications and procedures. This also played a role in the patient’s health. As far as the patient social determinants of health, this patient was educated and is currently retired. They are living off retirement and has a fixed income. This patient’s diet was not well balanced as they only have access to cheap food that lasted a long time. These factors play a big role in the patient’s health. Learning this information on this patient allows me to inquire about what the health care system is doing for the patient. This patient needs more access to health care and could benefit from referrals to primary care offices, physical therapists, and other health care teams that are closer to this patient’s residence. This could ultimately improve the patient’s health as they have the resources to improve their quality of life. The health care team has done a good job at educating and informing the patient on what needs to be done upon discharge. Education on medications, diagnosis, and nutrition is key to maintaining good health. Learning from this patient has allowed me the opportunity to grow as a nurse.

            I am a very different nurse now in comparison to the beginning of the semester. I was not as confident in my capabilities and knowledge as I am now. These skills have been strengthened through each clinical rotation. I got to practice important nursing skills which has built my confidence. Patient and team communication was not as good as it is now. This came from talking to numerous patients and collaborating with different health care members. These experiences are invaluable to my knowledge and have helped me grow as a nurse. Growth is an important part in nursing, and it comes each time you encounter a patient. You learn new things and learn new strategies to help provide the best care possible.

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Death With Dignity

Death with dignity is a very important topic as it can provide patients with a sense of comfort and give respect during their late stages of life. End of life can be challenging for patient as they experience a roller coaster of emotions including pain. Personally, I agree with physician assisted death as it gives the patient the control over their care. Instead of suffering from a terminal illness and waiting for themselves to die, it gives the patient the choice and terms on when they would like to no longer exist. I had a family member who was suffering from cancer and it was very challenging to watch them suffer knowing there is nothing that can be done. This topic can be challenging for some to discuss as they can have personal experiences that influence their viewpoint. Further research can be beneficial as it can provide more information on the topic and how it can affect patient care.

After viewing various literature, I have learned a great deal of information on death with dignity. I was surprised with how many states in the US have this process for patients. I assumed, with it being a very controversial topic, that there would be only one or two jurisdictions that allowed assisted death. With this, I also learned about some of the criteria that accompanies it. The patient must be of a certain age, be diagnosed with a terminal illness, and have decision making capacity. This process can challenge the first ethical principle of nonmaleficence as it directly causes the patient to die. This can a difficult concept as it is counteracting on what nurses and health care providers pride themselves on. Yet, the great picture should be looked at in these scenarios. If the patient can make decisions and a terminally ill diagnosis is made, then the decision should be in the hands of the patient. Death with dignity should be a “treatment” option that of which a patient can elect to go proceed with. This “treatment” option would be accompanied with consent and all other required documents for procedures. Healthcare workers look to help the quality of life in patients and with death with dignity, this can be accommodated. When dealing with terminally ill patient, health care workers are only providing comforting measure and prolonging the patient’s life, yet it may not be improving quality at all. Looking at the big picture can shed light into how a patient is feeling and can ultimately lead to providing the best care that health care workers can.

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Electronic Health Records

The use of electronic health records can be very important in when it comes to patient care. The patient’s information is uploaded in real-time so that all people holding the capability can look when needed. Having the records held online allows for easy access and control over their own records. The health records can include diagnosis, medications, immunizations, allergies, lab results, and so on. The implementation of HIE and electronic health records is a huge jump the medical field. These records can be accessed on smart phones, tablets, and anywhere internet access iv available. This can allow physicians and the health care team to access this data when needed.

HIE allows the health care team to be more efficient and provide better quality when it comes to patient care. Instead of forcing the medical staff to hold records in filing cabinets or in boxes, it is all virtual and at the providers fingertips. Having information such as vital signs submitted in real-time, it can reduce the readmission risk, reduce medication errors, decrease duplication of testing, and improve how physicians diagnose patients. HIE also provides safe and confidential information so that each patient knows who is viewing their information and when they view the information. This tracking system that is apart of HIE is used to prevent any breaches in HIPAA and ensures only the allowed people to view the records. Electronic health records can enhance how care is provided to all patients.

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Trauma Informed Care

Trauma can have a significant impact on psychological, physical, spiritual, environmental, and social well-being. It can be life changing for a person to experience a traumatic event as it can stay with them for the rest of their lives. Traumatic experiences can be very damaging to a person’s mental health. The event or events that have occurred can trigger future negative reactions to things that resemble their traumatic event. Symptoms such as depression and anxiety can be directly correlated to trauma as a secondary diagnosis. A person’s physical well-being is also affected as well. Eating habits can diminish or escalate, sleep schedule can be derailed, and activity levels can plummet. These actions present as a person tries to cope with their traumatic experience or be a lasting effect of going through a traumatic experience. Socially, a person can become reserved and isolate themselves from others. Traumatic events can impact a person in ways that could be crippling. It is important to understand what happened during the event and try to work through the issues that present.

                 Adverse childhood experiences can develop into serious complications. Chronic illnesses, mental illness, and substance abuse are just a few examples of what can happen to an individual later in life due to ACEs. These events can cause things such as heart disease, diabetes, and respiratory illnesses. The stress that is induced from ACEs can cause physical damage to and individual. It can also cause mental inadequacies that can be life changing. It is important to recognize and establish early interventions to reduce further complications and reduce the occurrences of ACEs. Having programs available so that children can feel comfortable and safe when talking about their experiences. Promoting a healthy lifestyle is also very important in reducing the complications of ACE’s. Healthy eating, regular exercise, mindful thinking, and proper sleep can all help to reduce stress and promote well-being. This information is vital when practicing as a nurse.

               The Trauma-Informed Care principles are a key tool to use when handling a traumatic related situation. The principles look at understanding how trauma can impact a person in all facets of life and how that can be incorporated when giving care. The goal of patient care looks at the over all well-being rather than just the individual symptoms. When practicing, it is important to maintain patient safety. Providing the needed respect to allow a patient to feel safe both physically and mentally is key. Developing a trusting therapeutic relationship provokes a more safe and transparent care plan. This is important as a nurse because the patient will be more likely to express themselves which can help with diagnoses and maintaining their well-being. As a nurse, collaboration with peers and other health care professions will ultimately provide an enhanced care plan for all patients. This group work allows for sharing information between professions as well as with the patient. This entitles the patient to participate in their care and develop the course of treatment. Trauma informed care is very important in the healthcare role. It can drastically change the course of the patient’s health in a positive way.

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Public Health and Vulnerable Populations

The health or vulnerable and marginalized populations is widely underestimated which is a public health crisis. Many factors contribute and influence these populations. The individual, the environment, and the societal factors have a strong impact on their health The individual may have religious obligations that require them to not follow through with certain procedures. In the eyes of a health care worker this could be devastating, but it is important to recognize the different beliefs that people live by and how that can affect their health. An individual’s environment may not be able to support their needs. They could not have the needed facilities to treat what is needed resulting in a decreased health status. Society also plays a strong role in how well a person can maintain good health. Someone could live in a region where racial injustice is predominant. That person would not be able to go take care of themselves in the same sense that someone of different color could. All these factors contribute and influence the health of an individual and community. Money plays a huge role when it comes to and individual’s health as well. One may not be able to afford medical insurance and may have to pay out of pocket for procedures and appointments. One may have to choose between going to the doctor and putting food on their table. Individuals are likely to put aside medical conditions to afford more important things. This public health crisis needs to be rethought and changed in a way so that it is fair to everyone.

A keyway to start change is to rewire the way we think. For example, someone could decline getting a vaccine. Rather than just saying they should get the vaccine everyone is doing it; they should ask why. Many key things can influence how someone approaches health care. Not everyone is afforded the opportunity to make the best decisions possible. Does that person have health insurance? Transportation? Education? Resources? These drive the decisions we make yet some must set aside their health for a variety of reasons. As a community, we should look to help those less fortunate. Educate them, give them resources, give them the tools to help themselves. This ongoing public health crisis is important to everyone. We should all be educated and appreciate the things we have. When giving care, this information is important to know. As a nurse, I would educate patients and listen to their opinions. I would listen to what they have to say and try to help them the best I could. These populations are already at risk of decreased health it should be our job to help them.

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Final Reflection

This final project has been very interesting. Going into it, I did not think I would learn so much about the process and my topic. My groupmate and I worked really hard on this project and put everything we had into it. Many challenges presented but through communication and reasoning we were able to resolve it. This project has taught me how to collaborate with others in a way that is not usual. I have never written a paper with another person before but I really enjoyed it. I feel it requires a different set of skills from other collaboration activities. You have to work through every little detail and both agree on it before continuing. This will help me through my career when dealing with similar situations. For a future employer, I would want them to know that I stayed driven and positive during this project. I worked through each assignment diligently and completed it efficiently. From this project, I can contribute to critically appraising articles and help with examining them. I can identify good articles from bad articles by looking over the credentials and reading the article. I can positively contribute to the medical profession by participating in these articles and giving adequate input. Through this team process I was able to identify some of my strengths and weaknesses. I feel like I am strong in designing and articulating words in a way that makes sense and is meaningful. I feel like I need to work on my grammar capabilities as sometimes this was lacking. Over all the team process was very beneficial and provided great cooperation experience.

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Ethical Considerations For EBP

Reviewing the provided resources about nursing and ethics, my opinion has not changed. I understand further that the role of a nurse will entail ethics. This is because patients have a wide view on the practices that they want to participate in. Educating the patient and informing them of recommendations should be a priority of the nurse. With this, it comes down to what the patient feels comfortable doing based on their past experiences or practices. There is a common saying by George Santayana that goes, “Those who do not learn history are doomed to repeat it.” This is the case for ethics in nursing. Understanding what practices have been preformed before will help further the knowledge of the nurse. Taking a deeper dive into these practices can help further progress studies that examine the same variable. A nurse should have a good understanding of the events that have occurred in the past and what lead up to those events. This can help prevent possible complications that could arise. This course specifically has enhanced my knowledge of the relationship between nursing and ethics. This course looks at evidence based practices and how to read, interpret, and explain these articles. It starts with understanding what you are reading. Once you have the ability to interpret results and hold the ability to explain them, the nurse will be able to communicate the results and consider them in their practices. Evidence based practice looks at problem solving in the medical profession while incorporating the patient and family. This should be done with every evidence based article that revolves around care. A nurse should have the capability to participate in these studies once they understand the key concepts of EBP. Contributing can ultimately result in a better experience for the patient by looking at what works and what does not work. This class, along with my ethics class, have delivered home the importance of ethics in nursing. I have the knowledge to examine articles and understand how they can play a role in the care I am providing. In short, the job of the nurse is to provide the most exceptional care keeping in mind the beliefs, values, and morals of the patient.

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Effects of Covid-19 Reflection

The effects of Covid-19 on the population has been detrimental. It can be seen in all aspects such as physical, psychological, and social well-being. People mask up for going into the grocery store, maintain at least 6 feet social distance, and remain sheltered in their home for most of the pandemic. These precautions to contracting the virus have physical and mental effects that have damaged many. Society as we once knew, will never be the same. This pandemic has caused lasting effects in society and the health of civilians. Even though vaccinations have been on the rise, the effects of the pandemic can still be seen by everyone day to day. Personally, this pandemic has caused physical and mental stress that required perseverance and guidance to get through.

            Within the medical profession, I can see a side of the virus that most people are not able to see. As a health care aid, I get to be in contact with potential Covid positive patients that are going through a slew of symptoms. Seeing patients in a resident home at such a critical time makes me reflect on what I will be doing as a nurse. It makes me think about the care I am providing to the patient. I strive to help as many people as I can while providing the most efficient care. This is challenging when I have family and friends who are currently suffering themselves. I reflected on the situation at hand and it made me think deeply about what I was doing. I had to set aside my emotions of the pandemic and hold myself accountable. This was done through the right mindset and perseverance. I focused on the task that was currently right in front of me and achieved what I had to do. This allowed me to focus on my job and discover how important basic nursing concepts are through my role. I was educated on how important safety, decision making, and prioritizing is when it comes to being a nurse. I got to participate and observe in patient care in one of the most challenging times in health care. Without the essential nursing concepts, the patient would not receive effective and efficient care. This would ultimately result in a deteriorating client who would not be able to over come the effects of their disease. I reflected on the role of a nurse and how important it is to focus on the patients and what they need. The patient not only needs someone to physically take care of them, but also a support system through this unprecedented time. This pandemic has delivered a lot of questions as it relates to ethics, nursing practices and the development of nursing students.

            A student nurse has it challenging enough to get their feet wet during nursing school. A lot of practices and procedures are new and require hard work and dedication to achieve success. This pandemic has thrown a curve ball into what nursing students can expect from all aspects of what it takes to become a nurse. Yet, what still holds true, is that a nurse still needs to hold a leadership position in the community, profession, and social circle. The CDC has guided the community as to what prevention measures should be taken to reduce the risk of contracting the virus. The job of a nurse is to be a primary educator to patients and people around, so they understand these prevention measures. Remaining at least 6 feet social distance, preforming proper hand hygiene, wearing a mask, and getting regularly testing are all factor into key prevention education. The nurse should practice what they preach to ensure that the people they are educating understand the importance and know how to do such tasks. By holding this leadership role in the community, the prevention measure should become more effective as more people know what they should be doing. There has been a lot of debates surrounding the efficacy of the Covid-19 tests, whether masks are effective, and exactly how the virus works. It is best that the nurse educates themselves by looking at evidence-based articles that provide substantial evidence as to what is effective and not. Sharing this information should be a priority for the nurse as nurse’s don’t just care for their patient, they care for everyone in need. Doing so can more challenging than anything. There is always going to be people who disagree and that is okay. It is important as a nurse and a leader, that the information is spread just so that people are educated and can make decisions for themselves. The community needs nurses to step up to influence and help citizens during this time.

            The pandemic will have everlasting effects on the community. I believe that hygiene and prevention will play an important role in how things are done. The wellness of the community will become cleaner and focus on how to prevent further instances like this from happening again. This also brings along the negative effects of the pandemic that has been brought up. The mental health aspect of being in solidarity and isolated for an extended period can be challenging to many. The community is going to need time to heal after this prolonged exposure to a new way of life. It is going to need a strong support system full of many health care professions that are available for everyone. There will be new leadership positions for nurses that include further care in education, prevention, and treatment. These can include new practices for talking about mental health, delivering vaccines, and being apart of the patients support system. These things may not have been prevalent in past years, but with this pandemic, they should become priorities for every nurse and health care profession. These changes will not come easy, but everyone needs to do their part to keep themselves and their community safe.

            Society has been challenged to their limit during this unexpected pandemic. We collectively have come together as a group to solve this prevailing issue. We are unsure of what the future holds for us. With vaccine roll outs in full effect, we need to hunker down until we can return to some normalcy. The obstacles that we have faced have been overcome by dedication and hard work. Things will return to normal at some point, and it is important to keep that in mind. The well-being of people will return, and we will be stronger than we ever were. There is a light at the end of the tunnel, and we all need to stay focused, dedicated, and advocate for one another to achieve harmony.

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Assumptions

Ethics in the nursing profession is prevalent every day. Nurses have to guide themselves through various ethical situations and provide the best response. They need to be well aware of the situation on use resources such as evidence based articles to help explain and implement procedures and treatment. Examining these articles can help provide the patient with a sense of comfort as the nurse holds the knowledge to the ethics as they present. Generation of evidence can be done through various ways and can entail the contribution of the nurse. A nurse can report the symptoms the patient is receiving from the treatment and help navigate the causation of the symptoms. A nurse can also tell if the treatment is working effectively by examining the physical patient and trending labs results. This is done so that the medical profession can understand how a procedure of treatment is affecting the patient. It can also open up new ways to do such tasks that will better affect the patient in a positive way. Ethics plays a major role in providing care and it is the duty of the nurse to provide the best care by doing and participating in evidence based studies.

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